Four children have died since June from overdoses of iron tablets, an important health supplement for pregnant women and one of the deadliest poisons that can strike toddlers, county health officials said Wednesday.
Officials said the four deaths represented an unusually high number of poisonings of this kind.
In each case, the lethal doses of iron were ingested from common, commercially produced prenatal tablets recommended for pregnant women. The tablets can be purchased over the counter or by prescription.
Billie Weiss, an epidemiologist with the county Department of Health Services, speculated that the children, who ranged in age from 11 months to 18 months, might have thought the pills were candy. The pills were green and red, with a sweet coating, and "look like M & Ms," Weiss said.
"They apparently don't taste terrible if swallowed. These children didn't have a lot of teeth and were probably swallowing them," Weiss said.
The bottles that the children got into were purchased with so-called child-proof safety caps and carried warning labels in English and Spanish, Weiss said. But she said the caps appeared to have been left on loosely or not at all, and in one case the warning was in small letters.
The pills contained 325 milligrams of ferrous sulfate, the health officer said. Ten tablets at that strength is considered a lethal dose for a 1-year-old child, Weiss said.
"People do not perceive iron to be dangerous. But it is not benign. It is something that can be extremely dangerous," she said.
In one case, a 2-year-old girl fed her 1-year-old sister 35 to 40 tablets, Weiss said. In another case, the child was at the home of a baby-sitter who apparently had the iron tablets on hand because she was pregnant. Iron tablets in normal or prescribed doses do not harm a fetus.
Weiss said that during the same six-month period in which the children died, the Los Angeles Poison Control Center received more than 234 reports of non-lethal iron poisonings. During the 10-year period between 1982 and 1991, she said, three children died of acute iron poisoning in Los Angeles County. Nationally, iron poisoning claims the lives of about 14 children a year, she said.
Dr. Susan B. Tully, director of outpatient pediatrics at Los Angeles County Olive View Medical Center and a board member of the Poison Control Center, said iron tablets are the leading cause of poisonings for children under 5.
"Part of the problem is that iron is an inherently bad poison and . . . it is also a good thing for pregnant women," she said. "People should know it is a poison, remember to put the lid back on tightly and get it safely out of the way of children."
Symptoms of acute iron poisoning are vomiting, diarrhea and stomach pain, but not always, Weiss said. She said parents who suspect their children may have ingested iron tablets or vitamins with special iron supplements should call a poison control center immediately.